Since 1985, the number of human immunodeficiency virus (HIV)
tests provided annually through publicly funded counseling and
testing (CT) programs has continued to increase, with more than 2
million tests provided in 1991 (1). However, the success of CT
programs in reaching persons most at risk for infection and
transmission of HIV is unclear. To ensure that resources are used
as effectively as possible, CT programs must evaluate their ability
to reach persons at highest risk. This report summarizes an
assessment of HIV testing among street-recruited injecting-drug
users (IDUs), female sex partners of male IDUs, and female
prostitutes in southern Los Angeles County in 1991-1992.

From April 1991 through September 1992, anonymous street
interviews were conducted in Long Beach, California, and nearby
communities as part of activities sponsored by the CDC Acquired
Immunodeficiency Syndrome (AIDS) Community Demonstration Projects
(2). Interviews were conducted in 127 sites that had been
associated with high prevalences of drug abuse, prostitution, or
both. Trained interviewers familiar with the community and target
groups conducted 7734 brief, preliminary risk assessments in these
sites with English-speaking persons aged greater than or equal to
18 years; of these, 3097 persons were identified who met
eligibility criteria for the second portion of the on-street
interview that included questions about HIV risk, attitudes, and
HIV-testing history. Eligibility was based on self-reported
membership in one or more of four target populations (i.e., male
IDU, female IDU, female sex partner of male IDUs, and female
prostitute) and recent sexual or drug-use behavior (i.e., vaginal
or anal intercourse in the previous 30 days or needle sharing in
the previous 60 days)*. Participants received $2 in fast-food
certificates for completing the brief risk assessment or $5 in cash
for completing the full interview. Because the interviews were
conducted anonymously on the street, repeat interviews (n=704) were
identified and excluded from data analysis by using a subset of
unique identifiers that retained respondent anonymity (e.g., date
of birth, place of birth, ethnicity, and sex).

The statistical relation between CT service use and respondent
characteristics were assessed using two methods. First, chi-square
tests for general association were used to identify differences in
the percentage of persons reporting use of CT services. Second,
stepwise logistic regression was used to assess the unique
contribution each one of the identified respondent characteristics
made to the use of CT services.

Overall, 1709 (71.4%) persons reported having been tested for
HIV infection, including 466 (64.9%) of 718 male IDUs and 1243
(74.2%) of 1675 high-risk females. Among male IDUs, HIV-testing
history varied by race/ethnicity and sexual orientation, with black
and homosexual/bisexual males less likely to have been tested than
other male IDUs (Table_1). Among high-risk females, HIV-testing
history was related to race/ethnicity, age, sexual orientation, and
HIV risk, with females who were black, aged less than 30 years, and
heterosexual less likely to have been tested (Table_2).

When analyzed using stepwise logistic regression, only
nonblack race/ethnicity ** remained significantly related to
previous testing of males (odds ratio {OR}=1.5; 95% confidence
interval {CI}=1.1-2.1). Nonblack race/ethnicity (OR=2.1; 95%
CI=1.6-2.7), history of injecting-drug use (OR=1.9; 95% CI=1.5-
2.4), history of prostitution (OR=1.8; 95% CI=1.4-2.4), and having
a non-IDU sex partner (OR=1.5; 95% CI=1.1-1.9) were positively
associated with females having been tested for HIV.

Overall, 1512 (88.5%) persons reported having obtained their
test results, including 88.1% of male IDUs and 88.7% of high-risk
females. Among male IDUs, no respondent characteristics were
associated with receipt of test results (Table_1). Among
females,
race/ethnicity was significantly related to receipt of results (p
less than 0.01) (Table_2). Stepwise logistic regression
indicated
that both nonblack race/ethnicity (OR=2.2; 95% CI=1.5-3.2) and not
having an IDU partner (OR=1.5; 95% CI=1.1-2.1) were independently
associated with women having received HIV test results.
Reported by: RJ Wolitski, MA, B Radziszewska, PhD, California State
Univ, Long Beach. Behavioral and Prevention Research Br, Div of
Sexually Transmitted Diseases and HIV Prevention, National Center
for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Findings from CDC's 1989 National Health Interview
Survey (NHIS) indicated that in the United States, 41.5% of persons
at increased risk *** were tested for HIV infection and that
testing
rates were lower among blacks, Hispanics, and persons with less
than a high school education (3). The NHIS also documented higher
rates of CT among persons in metropolitan areas, the western United
States, and persons at increased risk. However, because the NHIS
sampling scheme targeted households, estimates for HIV testing
probably underrepresented some groups of at-risk persons (e.g.,
those who were homeless or who lived in transitional housing). When
compared with the NHIS results, the rates of self-reported testing
among the high-risk populations in southern Los Angeles County were
higher. In addition, these findings are consistent with information
from publicly funded testing sites in Los Angeles County, which
indicate comparable return rates (82%) for similar high-risk
persons (CDC unpublished data, 1993), and suggest that
HIV-prevention programs promoting CT in southern Los Angeles County
have been effectively extended to IDUs, female sex partners of male
IDUs, and street prostitutes. However, 37% of all at-risk persons
interviewed in this assessment had either not been tested or failed
to obtain their test results, emphasizing the need to continue to
offer CT and other HIV-prevention services to populations at high
risk.

One factor that may account for the lower rates of testing
among female sex partners of male IDUs in southern Los Angeles
County may be that a substantial proportion of these women did not
perceive themselves as being at high risk for HIV infection because
they did not personally inject drugs or engage in prostitution
(4,5). Only 55.5% of female sex partners of male IDUs who had no
history of drug injection or prostitution had been tested.

The findings of this report are subject to at least five
limitations. First, the total population of high-risk persons from
which the study sample was drawn was unknown. Second, because the
level of respondents' use of CT services was based on self-reports,
their reports of use of CT services may have been influenced by
perceived desirability of receiving a HIV test and test results.
Third, only minimal respondent characteristic information was
collected and available to make comparisons; additional client and
service delivery information is necessary for a comprehensive
evaluation of CT service use in this geographic area. Fourth,
because some of these persons may not have been tested in a
publicly funded CT site, these findings cannot be directly compared
with national data. Fifth, the racial/ethnic differences may have
reflected differences in factors such as socioeconomic status and
general use of health-care services.

High rates of AIDS cases continue to be observed in the
metropolitan Los Angeles County area (6). Self-reports of testing
in this assessment addressed neither how recently or how frequently
tests were obtained nor the results of tests. However, the high
level of self-reports of HIV testing among IDUs and high-risk women
in southern Los Angeles County is encouraging when compared with
what would have been predicted by findings from national surveys.
In continuing to offer HIV CT programs to populations at risk,
programs targeting women should emphasize that women's risk for HIV
infection is in part determined by the sexual and drug-related
practices of their male sex partners.

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